There are three main types of screening intended parents will be required to undergo as part of their surrogacy journey: psychosocial, genetic and physical.
Every intended father will be subjected to a thorough screening process as part of his surrogacy journey — this shouldn’t be something to fear or overly worry about. These screenings are meant to help ensure the health of your baby, your surrogate, and you in order to reach the best possible outcome.
Here are the types of screenings you can expect to undergo:
The process of becoming fathers via a gestational surrogate is an emotional one for everyone. Counseling is an essential part of the process. The American Society of Reproductive Medicine (ASRM) recommends conducting a Psychological Risk Assessment to flag any issues that could prevent a successful collaboration between intended parents and gestational carriers. This screening will also make sure you understand the egg donation and surrogacy process, as well as the risks of unsuccessful cycles, potential for miscarriage, and other potential challenges you may face throughout your journey. Additionally the mental health professional will discuss whether you desire a known donor, as well as the benefits of talking to your child early on about how they came to your family.
There will be a thorough discussion about your relationship with your gestational carrier — this conversation will help establish some ground rules to ensure you have a healthy relationship with your gestational carrier, and her partner if applicable. You may also develop methods for resolving potential conflict surrounding a carrier’s behavior, such as eating habits, drug and alcohol use, or any mixed emotions with regards to your sexual orientation or gender identity. Also, during this screening process, you will learn about the rights of your carrier — she will always have the right to make a decision over her body. She can refuse to accept medical interventions or testing, for instance, and will need to agree to the number of embryos to be transferred, or to decisions regarding abortion or reduction of a pregnancy. Your counselor will also ensure you fully explore the type of relationship you hope you and your child will have with your egg donor and surrogate in the future, as well as conversations that will arise with your child about how they were conceived.
Your psychosocial screening will also help match expectations between you and your gestational carrier. “Some of my intended parents want to be very involved with their surrogate, very communicative, other intended parents want to be more reserved,” said Dr. Guy Ringler, Partner, California Fertility Partners. “Same thing with the surrogate mothers.”
Genetic carrier screening
As per guidelines from the ASRM and FDA you and your partner if applicable will have had a recent physical exam and screening for recessive genes that can cause disease in children. Generally, if risk factors are identified, it is not necessarily a deal-breaker. You will be advised NOT to match with an egg donor that is a carrier for the same disease causing gene. If you decide to proceed with an embryo transfer of an embryo with a higher risk of a genetic disease the ASRM recommends that gestational carriers are informed and counseled about the risks as well.
“We need to understand your family tree and genetics,” said Mark Leondires of RMACT. “You might know your family history, but you won’t know what genetic skeletons are in your closet.” Between 50 to 70% of the population carry recessive genes that cause certain diseases — while you might not be impacted, if you combine your genetic material with someone else with the same genetic marker, you increase the chance that your child will be impacted.
Within six months of creating the embryos to be transferred to your gestational carrier, the ASRM requirements state that the genetic father should receive a complete physical examination. The exam will test for any sexually transmitted diseases such as HIV and Hepatitis C, among other health indicators. It’s important to note that HIV positive gay men can still become fathers via surrogacy through a process called “sperm washing.”
A sperm analysis will also be conducted during this time. Factors that might impact the health of your sperm include: smoking, steroid use, and certain medications — like the popular hair growth drug Propecia (Finasteride). “I take all my guys off of Propecia,” said Dr. Guy Ringler of California Fertility Partners. “Oftentimes kicking and screaming.”
Testosterone use, in particular, has an adverse effect on sperm production. “It can actually make your sperm count very low,” said Dr. Gerald Goldstein of Fertility Specialists of Texas. “So we often want to make sure you’ve had a semen analysis even before you see us.”
The good news, said Dr. Mark Leondires, Founder and Medical Director of RMA of Connecticut and Gay Parents To Be, is that adjusting certain lifestyle behaviors over a three month period can often be enough to ensure high quality soon. “The sperm that you produce in March have been growing in the testicle since January,” he said. “So if you have lifestyle choices that aren’t helpful for sperm, you can change those, and actually get a better sperm specimen.” While this might be enough to ensure you are part of the 98% of men who are able to produce a healthy sperm specimen, 2% of intended fathers may still need to see a urologist for further interventions.
It’s important to know that men who are HIV positive can still pursue surrogacy. “But there are additional steps we have to do in the treatment process to help minimize the risk of transmitting the HIV to the embryo and surrogate mother,” said Dr. Ringler of California Fertility Partners.
Experts interviewed for this article:
- Dr. Mark Leondires, Founder and Medical Director, RMA of Connecticut and Gay Parents To Be
- Dr. Guy Ringler, Partner, California Fertility Partners
- Dr. Jerald S. Goldstein, Founder and Medical Director, Fertility Specialists of Texas
- Dr. Daniel Skora, Reproductive Endocrinologist, Fertility Specialists of Texas